Immunosuppressive therapy: Difference between revisions

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== Specific Medications ==
  
== Specific Medications ==
   
−
{| class="wikitable"
 +
{| class="wikitable sortable"
 
! Medications
  
! Medications
 
! Target
  
! Target
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|-
  
|-
 
| [[Rituximab]]
  
| [[Rituximab]]
−
| CD20, on B cells
 +
| Anti-CD20 antibody, on B cells
 
| Long-term B cell depletion
  
| Long-term B cell depletion
  +
|-
  +
|[[Ocrelizumab]]
  +
|Anti-CD20 antibody
  +
|
 
|-
  
|-
 
| [[Natalizumab]]
  
| [[Natalizumab]]
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| Bruton's tyrosine kinase (BTK), on B cells
  
| Bruton's tyrosine kinase (BTK), on B cells
 
| Invasive aspergillosis and other fungal infections
  
| Invasive aspergillosis and other fungal infections
  +
|-
  +
|Steroids
  +
|
  +
|
  +
|-
  +
|[[Cyclosphosphamide]]
  +
|Antimetabolite
  +
|
  +
|-
  +
|[[Leflunomide]]
  +
|Antimetabolite
  +
|
  +
|-
  +
|[[Methotrexate]]
  +
|Antimetabolite
  +
|
  +
|-
  +
|[[Azathioprine]]
  +
|Antimetabolite
  +
|
  +
|-
  +
|[[6-mercaptopurine]]
  +
|Antimetabolite
  +
|
  +
|-
  +
|[[Mycophenolic acid]]
  +
|Antimetabolite
  +
|
  +
|-
  +
|[[Mycophenolate mofetil]]
  +
|Antimetabolite
  +
|
  +
|-
  +
|[[Tacrolimus]]
  +
|Calcineurin inhibitor
  +
|
  +
|-
  +
|[[Cyclosporine]]
  +
|Calcineurin inhibitor
  +
|
  +
|-
  +
|[[Sirolimus]]
  +
|Calcineurin inhibitor
  +
|
  +
|-
  +
|[[Baricitinib]]
  +
|JAK inhibitor
  +
|
  +
|-
  +
|[[Tofacitinib]]
  +
|JAK inhibitor
  +
|
  +
|-
  +
|[[Upadacitinib]]
  +
|JAK inhibitor
  +
|
  +
|-
  +
|[[Adalimumab]]
  +
|Anti-TNF antibody
  +
|
  +
|-
  +
|[[Golimumab]]
  +
|Anti-TNF antibody
  +
|
  +
|-
  +
|[[Certolizumab pegol]]
  +
|Anti-TNF antibody
  +
|
  +
|-
  +
|[[Etanercept]]
  +
|Anti-TNF
  +
|
  +
|-
  +
|[[Infliximab]]
  +
|Anti-TNF antibody
  +
|
  +
|-
  +
|[[Sulfasalazine]]
  +
|Anti-inflammatory
  +
|
  +
|-
  +
|[[5-aminosalicylic acid]] and [[mesalamine]]
  +
|Anti-inflammatory
  +
|
  +
|-
  +
|[[Anakinra]]
  +
|IL-1 receptor antagonist
  +
|
  +
|-
  +
|[[Canakinumab]]
  +
|IL-1 receptor antagonist
  +
|
  +
|-
  +
|[[Tocilizumab]]
  +
|Anti-IL6
  +
|
  +
|-
  +
|[[Sarilumab]]
  +
|Anti-IL6
  +
|
  +
|-
  +
|[[Ustekinumab]]
  +
|Anti-IL12/IL23
  +
|
  +
|-
  +
|[[Secukinumab]]
  +
|Anti-IL17
  +
|
  +
|-
  +
|[[Ixekizumab]]
  +
|Anti-IL17
  +
|
  +
|-
  +
|[[Brodalumab]]
  +
|Anti-IL17 receptor
  +
|
  +
|-
  +
|[[Belimumab]]
  +
|Anti-BLyS
  +
|
  +
|-
  +
|[[Guselkumab]]
  +
|Anti-IL23
  +
|
  +
|-
  +
|[[Risankizumab]]
  +
|Anti-IL23
  +
|
  +
|-
  +
|[[Abatacept]]
  +
|Selective T-cell costimulation blocker
  +
|
  +
|-
  +
|[[Fingolimod]]
  +
|Selective T-cell costimulation blocker
  +
|
  +
|-
  +
|[[Siponimod]]
  +
|S1PR agonist
  +
|
  +
|-
  +
|[[Ozanimod]]
  +
|S1PR agonist
  +
|
  +
|-
  +
|[[Apremilast]]
  +
|Phosphodiesterase inhibitor
  +
|
  +
|-
  +
|[[Vedolizumab]]
  +
|Anti-integrin
  +
|
 
|}
  
|}
   

Revision as of 13:03, 2 November 2021

Screening

Before starting immunosuppressive therapy, consider the following investigations:

  • Tuberculin skin test
  • Strongyloides serology, if from endemic country
  • Hep B and C serology
  • Cytomegalovirus serology
  • HIV serology

Management

  • Latent TB infection: start treatment at least 4 weeks prior to starting the biologic

Specific Medications

Medications Target Specific Risks
Eculizumab C5 complement Meningococcus (very high risk), needs MCV4 + MenB + pen prophylaxis
Rituximab Anti-CD20 antibody, on B cells Long-term B cell depletion
Ocrelizumab Anti-CD20 antibody
Natalizumab α4-integrin, on all leukocytes except neutrophils JC virus
Ibrutinib Bruton's tyrosine kinase (BTK), on B cells Invasive aspergillosis and other fungal infections
Steroids
Cyclosphosphamide Antimetabolite
Leflunomide Antimetabolite
Methotrexate Antimetabolite
Azathioprine Antimetabolite
6-mercaptopurine Antimetabolite
Mycophenolic acid Antimetabolite
Mycophenolate mofetil Antimetabolite
Tacrolimus Calcineurin inhibitor
Cyclosporine Calcineurin inhibitor
Sirolimus Calcineurin inhibitor
Baricitinib JAK inhibitor
Tofacitinib JAK inhibitor
Upadacitinib JAK inhibitor
Adalimumab Anti-TNF antibody
Golimumab Anti-TNF antibody
Certolizumab pegol Anti-TNF antibody
Etanercept Anti-TNF
Infliximab Anti-TNF antibody
Sulfasalazine Anti-inflammatory
5-aminosalicylic acid and mesalamine Anti-inflammatory
Anakinra IL-1 receptor antagonist
Canakinumab IL-1 receptor antagonist
Tocilizumab Anti-IL6
Sarilumab Anti-IL6
Ustekinumab Anti-IL12/IL23
Secukinumab Anti-IL17
Ixekizumab Anti-IL17
Brodalumab Anti-IL17 receptor
Belimumab Anti-BLyS
Guselkumab Anti-IL23
Risankizumab Anti-IL23
Abatacept Selective T-cell costimulation blocker
Fingolimod Selective T-cell costimulation blocker
Siponimod S1PR agonist
Ozanimod S1PR agonist
Apremilast Phosphodiesterase inhibitor
Vedolizumab Anti-integrin
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